HomeMy WebLinkAboutBLD2023-00169 - BLD CD Environmental Health Review - 2/9/2023 .
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G-'�'-°^;it MASON COUNTY COMMUNITY SERVICES Permit No: i ;? "
e' PERMIT ASSISTANCE CENTER:
',n. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED!; C',;'•.y 615 W.Aldcr Street,Shelton,WA 98584 � //* : ,• Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone`` v Belfair(360)275-4467•Phone Elm:(360)482-5269 F E g 09 2023
BUILDING PERMIT APPLICATION ••�I ����// Alder Strcct
PROPERTY OWNER INFORMATION: CONTRAC 'OR INFORRIAlc)i'Gr
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NAME: c,1r� ��Lt' ,G-- ; -- ' , NAME:/�c �i�►f/,�•I T2 ". '/�1'l17''
MAIL A DRESS: > 2 -, ! MAILIt •AD S •
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CITY: STATE: ' / ZIP: CIT : -� STATE: - P: (- C rn
PHO 1 ; / -7! (� PHO - .•
PHONE#2: •
EMAIL
E � -�i. II . . -"f rAL&I REG# EXP._/_/_
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ _ X
NAME EMAIL m 0
MAILING ADDRESS CITY STATE ZIP D Z
PHONE CELL r
PARCEL INFORMATION: _� =7
PARCEL NUMBER(12 Digit Number),?t / .Li �.-,:.11 ZONING Z
LEGAL DESCRIPTIODL((Abbrevia"3) FIRE D] TRIC —
SITE ADDRESS C ! / / ylo i7/u�' l��'> CITY. �j ? %I l")l,
DIRECTIONS TO SITE ADDRESS / r
• IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc).
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Pan/s]oLBlag)❑ NO❑ to �2�
DESCRIBE WORK I Y IriC9, mYWDt 9 1L "e)eitiI-0Or l Gt�"' • t1 rj`J — k.147
SQUARE FOOTAGE: (proposidt
1ST FLOOR IC.10 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURE9 HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
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MAKE L-e41 ; iJ - . DEL 7_ YE C- - LENGTH Ci
WIDTH ) BEDROOMS , BATHS ? SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEWX EXISTING 0
PLUMBING IN STRUCTURE? YES4 NO❑ If yes,5attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO1 EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS ✓� TOTAL BEDROOMS "�
OWNER acknowlecges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgemert of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
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Signature of OWNER(Must be slgnEtl by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIREBLICHE HEALTH
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PUBLIC HEALTH �V'C,-�SlA
EH Setbacks
A.) Draintield/Reserve requires 10'setback from footing/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of •
'fL)Grainfield/Reserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area
EH APPROVED
Rhonda Thompson 02/27/2023 `) eve!
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